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Appraisal systems for psychiatric residents: Is it time for change?
Accepted Manuscript Title: Appraisal systems for psychiatric residents: Is it time for change? Author: Sundar Gnanavel PII: DOI: Reference:
S1876-2018(14)00133-6 http://dx.doi.org/doi:10.1016/j.ajp.2014.05.013 AJP 603
To appear in: Received date: Revised date: Accepted date:
2-5-2014 26-5-2014 28-5-2014
Please cite this article as: Gnanavel, S.,Appraisal systems for psychiatric residents: Is it time for change?, Asian Journal of Psychiatry (2014), http://dx.doi.org/10.1016/j.ajp.2014.05.013 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Dear Sir, Appraisal system refers to periodic formal assessment of performance against the elements of one's job. This includes summative feedback which aims to measure performance for
ip t
the purpose of ranking, grading or determining whether predetermined standards of practice are being met and formative feedback that refers aims only to improve or modify the learner's behavior (Ibrahim et al., 2014). Effectiveness of current appraisal systems for psychiatric
cr
residents, particularly in Asia, is an oft-neglected area of research in academic psychiatry. The current appraisal systems often include unstructured informal feedback during the ward rounds
us
or academic discussions and a formal appraisal cum evaluation procedure that is undertaken at pre-fixed time points and as an exit procedure on culmination of the residency program.
an
However, it is highly questionable and debatable if the current appraisal systems actually are actually effective in providing adequate and appropriate feedback to residents in a timely
M
manner.
A Dutch study that explored the appraisal system of psychiatric residents highlights the importance of evolving a mutual appraisal system for the trainees and trainers which would serve
d
as a complementary appraisal mechanism that would generate valuable bidirectional feedback
te
(De Boer et al., 2007). Some literature exists on appraisal system for medical students, interns and residents of other specialities and the observations from these studies can be extrapolated to
Ac ce p
psychiatric residents as well. For example, a recent Australian study pertaining to medical intern’s perception of existing appraisal systems indicate preference for the immediate clinical supervisor (eg. registrar rather than consultants) for providing formal feedback and requirement of a formal mid-term appraisal in addition to exit (final) evaluation.1 A recent study also demonstrates the possibility of using structured peer feedback as an effective and an easily replicable alternative. The author’s observation that by the end of the study, the comfort level with this type of appraisal system had increased manifold was a noteworthy observation of the study (Snydman et al., 2013). An interesting early study on an appraisal system for family medicine residents used a system of “resident appraisal profile” (RAP) which is essentially a daily supervisor entered computerized feedback based on the day’s cases on multiple parameters. The authors described the system as more constructive since daily formal feedback resulted in “desensitization by flooding” resulting in the trainees actually looking forward to the day’s
Page 1 of 2
feedback with eagerness without the associated anxiety of being placed under scrutiny (Ellison et al., 1987). Though no one system can be universally replicable and fool-proof, incorporation of multiple such salient observations from these previous endeavours by astute academicians might result in
ip t
development of better appraisal systems for psychiatric residents. Of course, local factors and the cultural sensitivity need to be considered prior to incorporation of such changes. Ideally an
cr
appraisal system should not always be used as a synonym to an evaluation system and combined together. It should rather exist as an unique entity in itself since the objectives of an appraisal and
us
an appraisal cum evaluation system is radically different. Facilitation of promotion of clinical competency and knowledge rather than fear of scrutiny should be the central theme of any
an
appraisal system. Appraisal systems constitute a vital area of research in academic psychiatry with multiple ramifications and hence needs to be taken up with all enthusiasm involving all the
M
stake-holders (both trainers and trainees). REFERENCES:
d
Ibrahim, J., MacPhail, A., Chadwick, L., Jeffcott, S, 2014. Interns' perceptions of performance feedback. Med. Educ. 48 417–429.
te
De Boer, I.A., Kool, J.A, Schoevers, R.A, 2007. Educational supervision in psychiatric training, the resident's and the teacher's perspective. Tijdschrift .voor. Psychiatrie. 49 (10) 693 – 703.
Ac ce p
Snydman, L., Chandler, D., Rencic, J., Sung, Y.C, 2013. Peer observation and feedback of resident teaching. Clin. Teach. 10 (1) 9-14. Ellison, P.A., 1987. Resident- Appraisal profile. Can. Fam. Physician. 33 2739-41.
Page 2 of 2
S1876-2018(14)00133-6 http://dx.doi.org/doi:10.1016/j.ajp.2014.05.013 AJP 603
To appear in: Received date: Revised date: Accepted date:
2-5-2014 26-5-2014 28-5-2014
Please cite this article as: Gnanavel, S.,Appraisal systems for psychiatric residents: Is it time for change?, Asian Journal of Psychiatry (2014), http://dx.doi.org/10.1016/j.ajp.2014.05.013 This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain.
Dear Sir, Appraisal system refers to periodic formal assessment of performance against the elements of one's job. This includes summative feedback which aims to measure performance for
ip t
the purpose of ranking, grading or determining whether predetermined standards of practice are being met and formative feedback that refers aims only to improve or modify the learner's behavior (Ibrahim et al., 2014). Effectiveness of current appraisal systems for psychiatric
cr
residents, particularly in Asia, is an oft-neglected area of research in academic psychiatry. The current appraisal systems often include unstructured informal feedback during the ward rounds
us
or academic discussions and a formal appraisal cum evaluation procedure that is undertaken at pre-fixed time points and as an exit procedure on culmination of the residency program.
an
However, it is highly questionable and debatable if the current appraisal systems actually are actually effective in providing adequate and appropriate feedback to residents in a timely
M
manner.
A Dutch study that explored the appraisal system of psychiatric residents highlights the importance of evolving a mutual appraisal system for the trainees and trainers which would serve
d
as a complementary appraisal mechanism that would generate valuable bidirectional feedback
te
(De Boer et al., 2007). Some literature exists on appraisal system for medical students, interns and residents of other specialities and the observations from these studies can be extrapolated to
Ac ce p
psychiatric residents as well. For example, a recent Australian study pertaining to medical intern’s perception of existing appraisal systems indicate preference for the immediate clinical supervisor (eg. registrar rather than consultants) for providing formal feedback and requirement of a formal mid-term appraisal in addition to exit (final) evaluation.1 A recent study also demonstrates the possibility of using structured peer feedback as an effective and an easily replicable alternative. The author’s observation that by the end of the study, the comfort level with this type of appraisal system had increased manifold was a noteworthy observation of the study (Snydman et al., 2013). An interesting early study on an appraisal system for family medicine residents used a system of “resident appraisal profile” (RAP) which is essentially a daily supervisor entered computerized feedback based on the day’s cases on multiple parameters. The authors described the system as more constructive since daily formal feedback resulted in “desensitization by flooding” resulting in the trainees actually looking forward to the day’s
Page 1 of 2
feedback with eagerness without the associated anxiety of being placed under scrutiny (Ellison et al., 1987). Though no one system can be universally replicable and fool-proof, incorporation of multiple such salient observations from these previous endeavours by astute academicians might result in
ip t
development of better appraisal systems for psychiatric residents. Of course, local factors and the cultural sensitivity need to be considered prior to incorporation of such changes. Ideally an
cr
appraisal system should not always be used as a synonym to an evaluation system and combined together. It should rather exist as an unique entity in itself since the objectives of an appraisal and
us
an appraisal cum evaluation system is radically different. Facilitation of promotion of clinical competency and knowledge rather than fear of scrutiny should be the central theme of any
an
appraisal system. Appraisal systems constitute a vital area of research in academic psychiatry with multiple ramifications and hence needs to be taken up with all enthusiasm involving all the
M
stake-holders (both trainers and trainees). REFERENCES:
d
Ibrahim, J., MacPhail, A., Chadwick, L., Jeffcott, S, 2014. Interns' perceptions of performance feedback. Med. Educ. 48 417–429.
te
De Boer, I.A., Kool, J.A, Schoevers, R.A, 2007. Educational supervision in psychiatric training, the resident's and the teacher's perspective. Tijdschrift .voor. Psychiatrie. 49 (10) 693 – 703.
Ac ce p
Snydman, L., Chandler, D., Rencic, J., Sung, Y.C, 2013. Peer observation and feedback of resident teaching. Clin. Teach. 10 (1) 9-14. Ellison, P.A., 1987. Resident- Appraisal profile. Can. Fam. Physician. 33 2739-41.
Page 2 of 2